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Pyogenic spondylodiscitis is a primary infection of
the intervertebral disc and is a rare entity. Here, we describe the case of a
64-year-old male patient, a professional breeder, who attended the Emergency
Department with sciatica and back pain that was worsening for a week. The
patient had no history of surgery or trauma. The patient had poor oral hygiene.
Magnetic resonance imaging (MRI) scan showed lumbar spondylodiscitis, and blood
cultures revealed Streptococcus constellatus. The patient was initially
treated with vancomycin but due to renal failure deterioration, the treatment
was changed to daptomycin for 8 weeks. During hospitalization, he endured renal
injury and nosocomial respiratory tract infection. The patient was discharged
with no further complications. Follow-up revealed improvement of neurological
signs. In our case, it seems that poor oral hygiene was the cause of
bacteremia, which underlies the importance of a good oral health status in
immunocompromised patients not only to prevent but also to successfully
eliminate any dental source of infection. S. constellatus is an
extremely rare pathogen and to our knowledge only two other cases of pyogenic
spondylodiscitis are reported in the literature. Early diagnosis is very
important for the prognosis of these patients.
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